Background: While higher well-being at the population level (collective well-being, CWB) is linked to lower cardiovascular (CV) disease incidence and mortality, it is unknown if the collective well-being of a community influences CV risk beyond the individual-level well-being of those in that group. This cross-sectional study investigated the association between CWB, individual well-being, and individual CV outcomes.

Methods: We linked 2010-2012 combined ZIP code-level CWB from the Gallup Well-being Index to individual life satisfaction, clinical factors, and behavioral factors from the Reasons for Geographic and Racial Differences in Stroke study (n=17,014). We estimated mixed effects generalized linear regression models where CWB and individual well-being (both measured as self-reported current life satisfaction) were independent variables, Life’s Simple 7 score and CV outcomes were dependent variables, including a random effect for county. Mortality was analyzed using a Cox proportional hazards model. In secondary analyses we also adjusted for socioeconomic factors.

Results: Higher CWB was significantly associated with higher Life Simple 7 overall score (OR=1.15, P<0.001), as well as higher rates of non-smoking (OR=1.22, p<0.001), physical activity (OR:1.08; 95%CI: 1.02-1.15; p=0.005), glucose metric (OR:1.11; 95%CI: 1.03-1.19; P=0.004), healthy body mass index (BMI) (OR=1.17, p<0.001) and healthy blood pressure (OR=1.11, p=0.002), and lower CV mortality (HR=0.87, P=0.012), independent of the individual’s life satisfaction. After adjusting for individuals’ socioeconomic factors, CWB remained significantly linked to healthy BMI (OR=1.07, p=0.019).

Conclusion: This study shows that the CWB of the population within which an individual lives influences their CV risk independent of their individual well-being and risk factors. Enhancing CWB could be an effective strategy for reducing individual CV disease risk.